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Zhang H, Duan X, Zhang Y, Zhuang G, Cao D, Meng W, Yan M, Qi W. Association Between Monocyte-to-Lymphocyte Ratio and Hematoma Progression After Cerebral Contusion. Neurocrit Care 2024; 40:953-963. [PMID: 37848656 PMCID: PMC11147937 DOI: 10.1007/s12028-023-01857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The objective of this research was to examine the impact of the monocyte-to-lymphocyte ratio (MLR) on the advancement of hematoma after cerebral contusion. METHODS The clinical information and laboratory test findings of people with cerebral contusion were retrospectively analyzed. Using the tertiles of MLR, the study participants were categorized into three groups, enabling the evaluation of the correlation between MLR and the advancement of hematoma after cerebral contusion. RESULTS Among the cohort of patients showing progression, MLR levels were significantly higher compared with the nonprogress group (P < 0.001). The high MLR group had a significantly higher proportion of patients with hematoma progression compared with the medium and low MLR groups. However, the medium MLR group had a lower proportion of patients with hematoma progression compared with the low MLR group. High MLR levels were independently linked to a higher risk of hematoma progression (Odds Ratio 3.546, 95% Confidence Interval 1.187-10.597, P = 0.024). By incorporating factors such as Glasgow Coma Scale score on admission, anticoagulant/antiplatelet therapy, white blood cell count, and MLR into the model, the predictive performance of the model significantly improved (area under the curve 0.754). CONCLUSIONS Our study suggests that MLR may serve as a potential indicator for predicting the progression of hematoma after cerebral contusion. Further research is necessary to investigate the underlying pathological and physiological mechanisms that contribute to the association between MLR and the progression of hematoma after cerebral contusion and to explore its clinical implications.
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Affiliation(s)
- Huajun Zhang
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, 45 Taizhou Road, Guangling District, Yangzhou City, Jiangsu Province, China
- Graduate School of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaochun Duan
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, 45 Taizhou Road, Guangling District, Yangzhou City, Jiangsu Province, China
| | - Yimiao Zhang
- Graduate School of Shaanxi, University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Guoquan Zhuang
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, 45 Taizhou Road, Guangling District, Yangzhou City, Jiangsu Province, China
- Graduate School of Dalian Medical University, Dalian, Liaoning, China
| | - Demao Cao
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, 45 Taizhou Road, Guangling District, Yangzhou City, Jiangsu Province, China
| | - Wei Meng
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Muyang Yan
- Graduate School of Dalian Medical University, Dalian, Liaoning, China
| | - Wentao Qi
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, 45 Taizhou Road, Guangling District, Yangzhou City, Jiangsu Province, China.
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Guilan MB, Bagheri SR, Roshani R, Alimohammadi E. Red cell distribution width to lymphocyte ratio could serve as a new inflammatory biomarker for predicting hematoma expansion in patients with intracerebral hemorrhage. BMC Neurol 2024; 24:162. [PMID: 38750430 PMCID: PMC11095002 DOI: 10.1186/s12883-024-03669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Hematoma expansion is a critical factor associated with increased mortality and adverse outcomes in patients with intracerebral hemorrhage (ICH). Identifying and preventing hematoma expansion early on is crucial for effective therapeutic intervention. This study aimed to investigate the potential association between the Red cell distribution width to lymphocyte ratio (RDWLR) and hematoma expansion in ICH patients. METHODS We conducted a retrospective analysis of clinical data from 303 ICH patients treated at our department between May 2018 and May 2023. Demographic, clinical, radiological, and laboratory data, including RDWLR upon admission, were assessed. Binary logistic regression analysis was employed to determine independent associations between various variables and hematoma expansion. RESULTS The study included 303 ICH patients, comprising 167 (55.1%) males and 136 (44.9%) females, with a mean age of 65.25 ± 7.32 years at admission. Hematoma expansion occurred in 73 (24.1%) cases. Multivariate analysis revealed correlations between hematoma volume at baseline (OR, 2.73; 95% CI: 1.45 -4,78; P < 0.001), admission systolic blood pressure (OR, 2.98 ; 95% CI: 1.54-4.98; P < 0.001), Glasgow Coma Scale (GCS) (OR, 1.58; 95% CI: 1.25-2.46; P = 0.017), and RDWLR (OR, 1.58; 95% CI: 1.13-2.85; P = 0.022) and hematoma expansion in these patients. CONCLUSIONS Our findings suggest that RDWLR could serve as a new inflammatory biomarker for hematoma expansion in ICH patients. This cost-effective and readily available biomarker has the potential for early prediction of hematoma expansion in these patients.
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Affiliation(s)
- Milad Babaei Guilan
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of neurosurgery, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Rezvan Roshani
- Clinical Research Development Center, Taleghani and Imam Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Alimohammadi
- Department of neurosurgery, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran.
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Zhang D, Zhuang D, Li T, Liu X, Zhang Z, Zhu L, Tian F, Chen X, Li K, Chen W, Sheng J. An analysis of neutrophil-to-lymphocyte ratios and monocyte-to-lymphocyte ratios with six-month prognosis after cerebral contusions. Front Immunol 2024; 15:1336862. [PMID: 38545111 PMCID: PMC10967015 DOI: 10.3389/fimmu.2024.1336862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background and purpose Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) have been identified as potential prognostic markers in various conditions, including cancer, cardiovascular disease, and stroke. This study aims to investigate the dynamic changes of NLR and MLR following cerebral contusion and their associations with six-month outcomes. Methods Retrospective data were collected from January 2016 to April 2020, including patients diagnosed with cerebral contusion and discharged from two teaching-oriented tertiary hospitals in Southern China. Patient demographics, clinical manifestations, laboratory test results (neutrophil, monocyte, and lymphocyte counts) obtained at admission, 24 hours, and one week after cerebral contusion, as well as outcomes, were analyzed. An unfavorable outcome was defined as a Glasgow Outcome Score (GOS) of 0-3 at six months. Logistic regression analysis was performed to identify independent predictors of prognosis, while receiver characteristic curve analysis was used to determine the optimal cutoff values for NLR and MLR. Results A total of 552 patients (mean age 47.40, SD 17.09) were included, with 73.19% being male. Higher NLR at one-week post-cerebral contusion (adjusted OR = 4.19, 95%CI, 1.16 - 15.16, P = 0.029) and higher MLR at admission and at 24 h (5.80, 1.40 - 24.02, P = 0.015; 9.06, 1.45 - 56.54, P = 0.018, respectively) were significantly associated with a 6-month unfavorable prognosis after adjustment for other risk factors by multiple logistic regression. The NLR at admission and 24 hours, as well as the MLR at one week, were not significant predictors for a 6-month unfavorable prognosis. Based on receiver operating characteristic curve analysis, the optimal thresholds of NLR at 1 week and MLR at admission after cerebral contusion that best discriminated a unfavorable outcome at 6-month were 6.39 (81.60% sensitivity and 70.73% specificity) and 0.76 (55.47% sensitivity and 78.26% specificity), respectively. Conclusion NLR measured one week after cerebral contusion and MLR measured at admission may serve as predictive markers for a 6-month unfavorable prognosis. These ratios hold potential as parameters for risk stratification in patients with cerebral contusion, complementing established biomarkers in diagnosis and treatment. However, further prospective studies with larger cohorts are needed to validate these findings.
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Affiliation(s)
- Dangui Zhang
- Research Center of Translational Medicine, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Dongzhou Zhuang
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Tian Li
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Xueer Liu
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Zelin Zhang
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Lihong Zhu
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Fei Tian
- Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaoxuan Chen
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Kangsheng Li
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Weiqiang Chen
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiangtao Sheng
- Department of Microbiology and Immunology and Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, China
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Li T, Zhuang D, Xiao Y, Chen X, Zhong Y, Ou X, Peng H, Wang S, Chen W, Sheng J. A dynamic online nomogram for predicting death in hospital after aneurysmal subarachnoid hemorrhage. Eur J Med Res 2023; 28:432. [PMID: 37828549 PMCID: PMC10571411 DOI: 10.1186/s40001-023-01417-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND This study aimed to validate the efficacy the multiplication of neutrophils and monocytes (MNM) and a novel dynamic nomogram for predicting in-hospital death in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS Retrospective study was done on 986 patients with endovascular coiling for aSAH. Independent risk factors associated with in-hospital death were identified using both univariate and multivariate logistic regression analysis. In the development cohort, a dynamic nomogram of in-hospital deaths was introduced and made available online as a straightforward calculator. To predict the in-hospital death from the external validation cohort by nomogram, calibration analysis, decision curve analysis, and receiver operating characteristic analysis were carried out. RESULTS 72/687 patients (10.5%) in the development cohort and 31/299 patients (10.4%) in the validation cohort died. MNM was linked to in-hospital death in univariate and multivariate regression studies. In the development cohort, a unique nomogram demonstrated a high prediction ability for in-hospital death. According to the calibration curves, the nomogram has a reliable degree of consistency and calibration. With threshold probabilities between 10% and 90%, the nomogram's net benefit was superior to the basic model. The MNM and nomogram also exhibited good predictive values for in-hospital death in the validation cohort. CONCLUSIONS MNM is a novel predictor of in-hospital mortality in patients with aSAH. For aSAH patients, a dynamic nomogram is a useful technique for predicting in-hospital death.
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Affiliation(s)
- Tian Li
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515000, Guangdong, China
| | - Dongzhou Zhuang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, 900 Hospital, Fuzhou, 350025, China
| | - Yong Xiao
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, 57 Changping Road, Shantou, 515000, Guangdong, China
| | - Xiaoxuan Chen
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515000, Guangdong, China
| | - Yuan Zhong
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, 57 Changping Road, Shantou, 515000, Guangdong, China
| | - Xurong Ou
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, 57 Changping Road, Shantou, 515000, Guangdong, China
| | - Hui Peng
- Department of Neurosurgery, Affiliated Jieyang People's Hospital of Sun Yat-sen University, 107 Tianfu Road, Jieyang, 522000, China
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, 900 Hospital, Fuzhou, 350025, China.
| | - Weiqiang Chen
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, 57 Changping Road, Shantou, 515000, Guangdong, China.
| | - Jiangtao Sheng
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515000, Guangdong, China.
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Yao M, Sun M, Chen C, Jin L, Yang H, Li Y, Yin S. Novel pirfenidone derivatives: synthesis and biological evaluation. RSC Med Chem 2023; 14:1158-1164. [PMID: 37360397 PMCID: PMC10285743 DOI: 10.1039/d3md00072a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
In order to discover novel anti-pulmonary fibrosis agents, a series of novel pirfenidone derivatives were designed and synthesized. All compounds were investigated for their anti-pulmonary activity and characterized by 13C and 1H nuclear magnetic resonance and high-resolution mass spectrometry. Preliminary studies on their biological activity showed that all target compounds showed different degrees of inhibition on pulmonary fibrosis, and most of the derivatives were significantly better than pirfenidone.
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Affiliation(s)
- Maoling Yao
- Key Laboratory of General Chemistry of the National Ethnic Affairs Commission, School of Chemistry and Environment, Southwest Minzu University Chengdu 610041 China
| | - Maoru Sun
- Key Laboratory of General Chemistry of the National Ethnic Affairs Commission, School of Chemistry and Environment, Southwest Minzu University Chengdu 610041 China
| | - Congdi Chen
- College of Chemistry and Life Science, Chengdu Normal University Chengdu 611130 China
| | - Liming Jin
- Key Laboratory of Biotechnology and Bioresources Utilization, Ministry of Education, Dalian Minzu University Dalian 116600 China
| | - Hongjun Yang
- Key Laboratory of General Chemistry of the National Ethnic Affairs Commission, School of Chemistry and Environment, Southwest Minzu University Chengdu 610041 China
| | - Yong Li
- Innovation Center of Nursing Research, Nursing Key Laboratoryof Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and, Collaborative Innovation Center of Biotherapy, Sichuan University Chengdu 610041 China
| | - Shufan Yin
- College of Chemistry, Sichuan University Chengdu 610000 China
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Natakusuma TISD, Mahadewa TGB, Maliawan S, Budayanti NNS, Senapathi TGA, Muliarta IM. Correlation of MLR with CRP and MPVPCR with LED in Traumatic Brain Injury. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND: Traumatic brain injury (TBI) contributes greatly to high rates of death and disability globally. It may be divided into primary and secondary injuries. Primary head injuries occur at the moment of impact which causes mechanical loads and accelerations both linearly and rotationally, causing injury to the brain. After the primary brain injury, further biochemical and cellular processes occur that lead to secondary injury. Secondary insult in TBI may lead to several neuroinflammation processes that are reflected on laboratory markers. The monocyte-lymphocyte ratio and mean platelet volume-platelet count ratio (MPVPCR) theoretically have the potential to be used as neuroinflammation markers in TBI.
AIM: This study was conducted to assess the relationship between monocyte-lymphocyte ratio (MLR), MPVPCR with both C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) regarded as inflammation markers in relation to secondary brain injury.
METHODS: This study was a cross-sectional prospective analytic observational study conducted at the Sanglah hospital emergency department from February to May 2022. Patients diagnosed with TBI aged 18 years and over that were willing to be included in the study by consecutive sampling. Patients with a history of autoimmune disease, history of taking immunosuppressant drugs, and fractures of > 2 long bones were excluded and the presence of infection characterized by fever was excluded from the study. History taking and physical examination were done to obtain data regarding age, gender, mechanism of injury, Glasgow Coma Scale, fainting duration, and memory loss. The blood sample was taken at 24 h after trauma to obtain MLR, MPVPCR, CRP, and ESR results. Pearson correlation test was done to determine the correlation between MLR and MPVPCR with CRP and LED.
RESULTS: There are a total of 85 patients included in this study with the mean of age which is 36 ± 2.5 years old. Most of them are men (71.3%) with the mean of GCS on admission which is 12. Mean ± (SD) of the monocyte, lymphocyte, and platelet was 1.12 ± 0.82 × 103/μL, 1.83 ± 1.69 × 103/μL, and 259.34 ± 85.79 × 103/μL consecutively. MLR with CRP had a weak positive correlation and was statistically significant (r = 0.215; p = 0.045), as well as MPVPCR with ESR also had a weak positive correlation and was statistically significant (r = 0.276; p = 0.010). While both MLR with ESR and MPVPCR with CRP had no correlation.
CONCLUSION: MLR can be an option representing CRP in predicting the magnitude of inflammation in head injury and MPVPCR can be considered to be used as a predictor of thrombotic phenomena in TBI.
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Zhu C, Li W, Zhang Y, Qianqian Li, Wang H. Association of cerebrospinal fluid CD4+/CD8+Ratio with 60-day functional outcome after intracerebral hemorrhage. Int J Immunopathol Pharmacol 2023; 37:3946320231207350. [PMID: 37853743 PMCID: PMC10588406 DOI: 10.1177/03946320231207350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023] Open
Abstract
Background: The immune inflammatory reaction has vital function in pathologic mechanism of critical intracerebral hemorrhage. It recently has been reported that CD4/CD8 ratio may represent a novel composite immune inflammatory marker to predict prognosis of critical intracerebral hemorrhage (ICH). Nevertheless, as for considering the effects of surgical evacuation upon initiation of immune inflammatory reactions, the association between cerebrospinal fluid (CSF) CD4/CD8 ratio and 60-day functional outcome of patients with critical ICH after surgery has not been investigated. Present study aimed to evaluate the predictive value concerning postoperative complement system and immunoglobulin, paired cerebrospinal fluid and peripheral blood lymphocyte subsets, as well as inflammation index before and after the operations upon the 60-day prognosis of patients with ICH.Methods: In total, 69 patients with acute critical ICH admitted in First Central Hospital of Baoding City from January to July in 2022 were prospectively enrolled. We recorded and analyzed the relevant clinical data. Laboratory parameters included postoperative lymphocyte subsets in paired cerebrospinal fluid and peripheral blood, inflammation index before and after operation. The associations between 60-day outcome and laboratory biomarkers were assessed by multivariable logistic regression analysis. Comparisons of predictive value regarding independent predictors was evaluated by receiver operating characteristic (ROC) curves.Results: In total, 51 patients with critical ICH exhibited poor outcomes at 60 days, which was associated with fever after surgery, hernia before surgery, SAH and lower Glasgow Coma Scale (GCS) at admission and large hematoma volume, greater CD3T%CSF, greater CD4T%CSF, and greater CD4/CD8 ratioCSF. CD4/CD8ratio CSF showcased significant predictive power by comparing with other laboratorial variables (AUC = 0.6808; cut-off = 1.61; sensitivity = 80.39%; specificity = 61.11%; 95% CI: 0.5232-0.8385; p = .0233), which was found to correlated linearly with postoperative fever, first CSF test time, CD3T% CSF, CD4T% CSF, CD8T% CSF, NKCSF, CD3T%PB, CD8T%PB, CD4/CD8 ratioPB, and glucoseCSF. Poor outcome at 60 days linearly correlated with CD4/CD8ratioCSF after adjustments. In 3-5 days after surgery tested CSF lymphocyte subsets, CD4/CD8ratioCSF ≥1.61 was associated with a higher risk for 60-day poor outcome comparing with corresponding subgroups.Conclusions: In association of critical ICH patient prognosis, CSF CD4/CD8 ratio, especially in 3-5 days after surgery, exhibited potential independent predictive ability for 60-day functional outcomes of patients with critical ICH.
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Affiliation(s)
- Chunying Zhu
- Department of Neuroscience Intensive Care Unit, The First Central Hospital of Baoding, Baoding, China
| | - Wei Li
- Department of Neuroscience Intensive Care Unit, The First Central Hospital of Baoding, Baoding, China
| | - Yingfu Zhang
- Endoscopic Diagnosis and Treatment Center, The First Central Hospital of Baoding, Baoding, China
| | - Qianqian Li
- Department of Neuroscience Intensive Care Unit, The First Central Hospital of Baoding, Baoding, China
| | - Huan Wang
- Department of Neuroscience Intensive Care Unit, The First Central Hospital of Baoding, Baoding, China
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Association of Monocyte-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios With Persistent Critical Illness in Patients With Severe Trauma. J Trauma Nurs 2022; 29:240-251. [DOI: 10.1097/jtn.0000000000000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Preoperative Inflammatory Markers and the Risk of Postoperative Delirium in Patients Undergoing Lumbar Spinal Fusion Surgery. J Clin Med 2022; 11:jcm11144085. [PMID: 35887857 PMCID: PMC9324332 DOI: 10.3390/jcm11144085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
We investigated the possible associations between postoperative delirium (POD) and routinely available preoperative inflammatory markers in patients undergoing lumbar spinal fusion surgery (LSFS) to explore the role of neuroinflammation and oxidative stress as risk factors for POD. We analyzed 11 years’ worth of data from the Smart Clinical Data Warehouse. We evaluated whether preoperative inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the CRP-to-albumin ratio (CAR), affected the development of POD in patients undergoing LSFS. Of the 3081 subjects included, 187 (7.4%) developed POD. A significant increase in NLR, MLR, and CAR levels was observed in POD patients (p < 0.001). A multivariate analysis showed that the second, third, and highest quartiles of the NLR were significantly associated with the development of POD (adjusted OR (95% CI): 2.28 (1.25−4.16], 2.48 (1.3−4.73], and 2.88 (1.39−5.96], respectively). A receiver operating characteristic curve analysis showed that the discriminative ability of the NLR, MLR, and CAR for predicting POD was low, but almost acceptable (AUC (95% CI): 0.60 (0.56−0.64], 0.61 (0.57−0.65], and 0.63 (0.59−0.67], respectively, p < 0.001). Increases in preoperative inflammatory markers, particularly the NLR, were associated with the development of POD, suggesting that a proinflammatory state is a potential pathophysiological mechanism of POD.
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Sheng J, Chen W, Zhuang D, Li T, Yang J, Cai S, Chen X, Liu X, Tian F, Huang M, Li L, Li K. A Clinical Predictive Nomogram for Traumatic Brain Parenchyma Hematoma Progression. Neurol Ther 2022; 11:185-203. [PMID: 34855160 PMCID: PMC8857351 DOI: 10.1007/s40120-021-00306-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Acute traumatic intraparenchymal hematoma (tICH) expansion is a major cause of clinical deterioration after brain contusion. Here, an accurate prediction tool for acute tICH expansion is proposed. METHODS A multicenter hospital-based study for multivariable prediction model was conducted among patients (889 patients in a development dataset and 264 individuals in an external validation dataset) with initial and follow-up computed tomography (CT) imaging for tICH volume evaluation. Semi-automated software was employed to assess tICH expansion. Two multivariate predictive models for acute tICH expansion were developed and externally validated. RESULTS A total of 198 (22.27%) individuals had remarkable acute tICH expansion. The novel Traumatic Parenchymatous Hematoma Expansion Aid (TPHEA) model retained several variables, including age, coagulopathy, baseline tICH volume, time to baseline CT time, subdural hemorrhage, a novel imaging marker of multihematoma fuzzy sign, and an inflammatory index of monocyte-to-lymphocyte ratio. Compared with multihematoma fuzzy sign, monocyte-to-lymphocyte ratio, and the basic model, the TPHEA model exhibited optimal discrimination, calibration, and clinical net benefits for patients with acute tICH expansion. A TPHEA nomogram was subsequently introduced from this model to facilitate clinical application. In an external dataset, this device showed good predicting performance for acute tICH expansion. CONCLUSIONS The main predictive factors in the TPHEA nomogram are the monocyte-to-lymphocyte ratio, baseline tICH volume, and multihematoma fuzzy sign. This user-friendly tool can estimate acute tICH expansion and optimize personalized treatments for individuals with brain contusion.
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Affiliation(s)
- Jiangtao Sheng
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong, Chin
| | - Weiqiang Chen
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Dongzhou Zhuang
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Tian Li
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong, China
| | - Jinhua Yang
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Shirong Cai
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Xiaoxuan Chen
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong, China
| | - Xueer Liu
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong, China
| | - Fei Tian
- Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Mindong Huang
- Department of Neurosurgery, Affiliated Jieyang Hospital of Sun Yat-Sen University, Jieyang, Guangdong, China
| | - Lianjie Li
- Department of Neurosurgery, Affiliated East Hospital of Xiamen University Medical College, Fuzhou, Fujian, China
| | - Kangsheng Li
- Department of Microbiology and Immunology, Guangdong Provincial Key Laboratory of Infectious Disease and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong, China
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Zhu Y, Xu L, Lin S, Chen Y, Han P, Lu Z. Establishment and validation of a prediction model for intraparenchymal hematoma expansion in patients with cerebral contusion: A reliable Nomogram. Clin Neurol Neurosurg 2021; 212:107079. [PMID: 34871991 DOI: 10.1016/j.clineuro.2021.107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Cerebral Contusion (CC) is one of the most serious injury types in patients with traumatic brain injury (TBI). Traumatic intraparenchymal hematoma (TICH) expansion severely affects the patient's prognosis. In this study, the baseline data, imaging features, and laboratory examinations of patients with CC were summarized and analyzed to develop and validate a nomogram predictive model assessing the risk factors for TICH expansion. METHODS Totally 258 patients were included and retrospectively analyzed herein, who met the CC inclusion criteria, from July 2018 to July 2021. TICH expansion was defined as increased hematoma volume ≥ 30% relative to primary volume or an absolute hematoma increase ≥ 5 ml at CT review. RESULTS Univariate and binary logistic regression analyses were performed to screen out the independent predictors significantly correlated with TICH expansion: Age, subdural hematoma (SDH), contusion site, multihematoma fuzzy sign (MFS), contusion volume, and traumatic coagulation abnormalities (TCA). Based on these, the nomogram model was established. The differences between the contusion volume and glasgow outcome scale (GOS) were analyzed by the nonparametric tests. Larger contusion volume was associated with poor prognosis. CONCLUSION This study established a Nomogram model to predict TICH expansion in patients with CC. Meanwhile, the study found that the risk of bleeding tended to decrease when the hematoma volume was > 15 ml, but the larger initial hematoma volume would indicate worse prognosis. We advocate the use of predictive models for TICH expansion risk assessment in hospitalized CC patients, which is low-cost and easy-to-apply, especially in acute settings.
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Affiliation(s)
- Yufeng Zhu
- Department of Graduate School,Qinghai University, Xining, Qinghai 810016,China.
| | - Lulu Xu
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China.
| | - Shengwu Lin
- Department of Graduate School,Qinghai University, Xining, Qinghai 810016,China.
| | - Yunxiao Chen
- Department of Graduate School,Wannan Medical College, Wuhu 241000, China.
| | - Pei Han
- Department of Neurosurgery,Qinghai Provincial People's Hospital, Xining, Qinghai 810007, China.
| | - Zhongsheng Lu
- Department of Neurosurgery,Qinghai Provincial People's Hospital, Xining, Qinghai 810007, China.
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Zhu Y, Jin X, Xu L, Han P, Lin S, Lu Z. Establishment and validation of prognosis model for patients with cerebral contusion. BMC Neurol 2021; 21:463. [PMID: 34844563 PMCID: PMC8628400 DOI: 10.1186/s12883-021-02482-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background And Objective Cerebral Contusion (CC) is one of the most serious injury types in patients with traumatic brain injury (TBI). In this study, the baseline data, imaging features and laboratory examinations of patients with CC were summarized and analyzed to develop and validate a prediction model of nomogram to evaluate the clinical outcomes of patients. Methods A total of 426 patients with cerebral contusion (CC) admitted to the People’s Hospital of Qinghai Province and Affiliated Hospital of Qingdao University from January 2018 to January 2021 were included in this study, We randomly divided the cohort into a training cohort (n = 284) and a validation cohort (n = 142) with a ratio of 2:1.At Least absolute shrinkage and selection operator (Lasso) regression were used for screening high-risk factors affecting patient prognosis and development of the predictive model. The identification ability and clinical application value of the prediction model were analyzed through the analysis of receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). Results Twelve independent prognostic factors, including age, Glasgow Coma Score (GCS), Basal cistern status, Midline shift (MLS), Third ventricle status, intracranial pressure (ICP) and CT grade of cerebral edema,etc., were selected by Lasso regression analysis and included in the nomogram. The model showed good predictive performance, with a C index of (0.87, 95% CI, 0.026–0.952) in the training cohort and (0.93, 95% CI, 0.032–0.965) in the validation cohort. Clinical decision curve analysis (DCA) also showed that the model brought high clinical benefits to patients. Conclusion This study established a high accuracy of nomogram model to predict the prognosis of patients with CC, its low cost, easy to promote, is especially applicable in the acute environment, at the same time, CSF-glucose/lactate ratio(C-G/L), volume of contusion, and mean CT values of edema zone, which were included for the first time in this study, were independent predictors of poor prognosis in patients with CC. However, this model still has some limitations and deficiencies, which require large sample and multi-center prospective studies to verify and improve our results. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02482-4.
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Affiliation(s)
- Yufeng Zhu
- Department of Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Xiaoqing Jin
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai, China
| | - Lulu Xu
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Pei Han
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai, China
| | - Shengwu Lin
- Department of Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Zhongsheng Lu
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai, China.
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Natakusuma TISD, Mahadewa TGB, Mardhika PE, Maliawan S, Senapathi TGA, Ryalino C. Role of Monocyte-to-lymphocyte Ratio, Mean Platelet Volume-to-Platelet Count Ratio, C-Reactive Protein and Erythrocyte Sedimentation Rate as Predictor of Severity in Secondary Traumatic Brain Injury: A Literature Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Secondary traumatic brain injury (TBI) is injury to the brain following primary TBI because of neuroinflammation as consequences of neuronal and glial cell injury which cause release of various inflammation cytokine and chemokine. Biomarker examination to predict the severity of secondary TBI is important to provide appropriate treatment to the patient. This article reviews possibility several common laboratory parameter such as monocyte-to-lymphocyte ratio (MLR), mean platelet volume-to-platelet count (PC) ratio (MPV-PCR), c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to predict severity of secondary TBI.
LITERATURE REVIEW: TBI activates microglia which increase infiltration and proliferation of monocyte. Neuroinflammation also increases thrombopoiesis which leads to increase megakaryocytes production. In the other hand, due to disruption of brain blood vessels because of trauma, coagulation cascade is also activated and leads to consumptive coagulopathy. These are reflected as high monocyte count, low PC, and high MPV. Lymphocyte count is reported low in TBI especially in poor outcome patients. CRP is an acute phase reactant that increased in inflammation condition. In TBI, increased production of Interleukin-6 leads to increase CRP production. In head injured patients, ESR level does not increase significantly in the acute phase of inflammation but last longer when compared to CRP.
CONCLUSION: MLR, MPV-PCR, CRP, and ESR could be predictor of severity in secondary TBI.
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